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Intake &Approval Sheet •(FoR PERMIT STAFF ONLY) • PERMIT# f d- O 7-.6 ge <br /> BUILDING . , , PLANNING" <br /> Intake OK by: Date: Intake OK by:Tat Assign To: Date: J l /2.. <br /> Intake Comments: Intake Comments: <br /> ❑ Route to Commercial Building ❑Attach to Project No. <br /> ❑ Route to Residential Building ❑ Route to Historic Reviewer <br /> ❑ Make this a"W"Permit ❑ OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone -14 <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No ❑Yes, Fin/Unfin Nonresidential Use <br /> Type of Construction - Residential Use MI)1- ictieni <br /> Occupancy Group Proposed No.of Dwelling Units: C <br /> Occupancy Load • • Total No.of Dwelling Units: <br /> Fire Sprinklers: ❑Update Existing Chew System El Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes ❑No <br /> Reason Sprinklers Required: "In Lieu"Fee:Type: Amount$ <br /> Fire Alarm: El Update Existing El New System ❑Not Req'd School Impact Fee: Total $ <br /> Reason Fire Alarm Required: Calculated: Credit: <br /> RCW 64.55 MF worksheet req'd for permit? ❑Yes ❑ No ❑Everett School Dist ❑Mukilteo School Dist <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes 0 No Additional Notes: <br /> VALUATION CALCULATION: Total$ 67 7P,'6 9 MM <br /> bi i 0 WI, (110 6-0.X V 1 /22 <br /> Approved By: Date: <br /> PUBLIC WORKS'- <br /> Intake OK by: Date: <br /> Additional Notes: Intake Comments: IPW Worksheet Needed if. <br /> II]Sys Dev Eval CDTraffic Mit Eval <br /> • <br /> I DSite Work or Drainage Proposed <br /> Date:aQ � tOZ Z_ 10Backflow Prevention for high hazard: <br /> Approved B <br /> �� / _(dental,medical,animals,mortuary,hospital, <br /> ;supportive housing) <br /> FIRE DEPARTMENT DRoute this folder for PW Review at end ---PW Review Worksheet <br /> Separate!Deferred Submittals Required: OThis project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND ❑Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: ; ❑This Permit is Approved by Public Works <br /> ❑See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: ❑A Separate PW Permit is Required(Permit#:PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(loin with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: ❑ Public Works has no scope---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> 4— <br />